title: Outcome following lumbar disc surgery: the role of fibrosis.
abstract: BACKGROUND
  Failed-back surgery syndrome remains a challenge for spinal surgeons. It can be related to several causes, including poor surgical indication, misdiagnosis, surgical technique failure, spondilodiscitis and fibrosis. Fibrosis has been associated with a poorer outcome in lumbar disc surgery, although its role in the generation of symptoms is not yet clear. In this study, the authors have analyzed any possible correlation between the clinical outcome and the degree of fibrosis.
  
  
  METHODS
  Forty consecutive patients were enrolled in a prospective study. All of them had operations in the lower lumbar disc in a single level for the first time. Three months after the operation they were submitted to clinical outcome evaluations and questionnaires, including Numeric Pain Rating scales (NPR) for lumbar and leg pain, the McGill Pain Questionnaire, The Quebec Back Pain Disability scale (QBPD) and Straight Leg Raising test. These data were correlated with the degree of fibrosis as revealed by Magnetic Resonance Imaging (MRI).
  
  
  RESULTS
  After 3 months, the NPR values for lumbar and leg pain ranged from 0 to 8 (mean 2.32 and 1.67 respectively). The values of the post-operative QBPD scale ranged from 1 to 71 (mean 25.9). Every patient showed a varied degree of fibrosis on MRI. However, statistical analysis depicted no significant correlation between fibrosis and a poorer clinical outcome for pain and disability.
  
  
  CONCLUSIONS
  The authors found no correlation between excessive fibrosis with lumbar and leg pain, disability or straight leg resistance. The role of fibrosis in the generation of symptoms in patients who have had lumbar disc surgery should be reevaluated.
authors.affiliation: Instituto de Neurologia de Curitiba, Abílio César Borges, 79/61, Curitiba, 80730-060, Brazil. daniel.neurocirurgia@uol.com.br
authors.forename: Daniel Benzecry
authors.initials: DB
authors.lastname: Almeida
authors.forename: Mirto Nelson
authors.initials: MN
authors.lastname: Prandini
authors.forename: Yumi
authors.initials: Y
authors.lastname: Awamura
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Vitola
authors.forename: Monica Pedro
authors.initials: MP
authors.lastname: Simião
authors.forename: Jeronimo Buzetti
authors.initials: JB
authors.lastname: Milano
authors.forename: Kelly Cristina
authors.initials: KC
authors.lastname: Bordignon
authors.forename: Mariane Pastuch
authors.initials: MP
authors.lastname: Ache
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ramina
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D017586:Diskectomy / Q000009:adverse effects*; D004388:Dura Mater / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D055111:Failed Back Surgery Syndrome / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005355:Fibrosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D013115:Spinal Canal / Q000473:pathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D017211:Treatment Failure; D055815:Young Adult